Alcohol and other substance use disorders (SUD) such as opioid use disorder (OUD) are serious problems affecting all segments of the US population. The impact of these conditions can be severe, including declines in health and quality of life, disability, and death. Evidence-based tools available to healthcare professionals for addressing these conditions in primary care, including screening and brief interventions (SBI), preventive counseling, and medication-assisted treatments, are underutilized, even as the burden of SUD continues to worsen. Primary care is an essential point of contact for addressing SUD, but significant gaps persist in training programs, implementation and resources. Despite over a decade of nationally funded implementation initiatives, the alcohol SBI/Screening Brief Intervention and Referral to Treatment (aSBI/SBIRT) model has uneven uptake across primary care practices. The aSBI model, for example, has earned a Grade B recommendation by the US Preventive Services Task Force (USPSTF). Yet, while the SBI components of SBIRT have shown efficacy for addressing risky alcohol use in primary care, the RT (referral and treatment) components have not, nor has SBI made a clear impact on other substances beyond alcohol. With a cadre of medications for treating AUD and OUD available for prescription by primary care clinicians, and more recent literature supporting the efficacy of medication therapy (MAT) for OUD uncoupled from counseling therapies, it is time to move past treatment referral in primary care to directly providing MAT for AUD and OUD. This program will use evidence based outreach and educational methods including short courses, asynchronous, computerized, interactive modules, and in-person professional academic detailing to deliver up to date knowledge and skills training to large and diverse groups of primary care professionals in the Greater Houston Metropolitan Area (GHMA) and the Rio Grande Valley (RGV), Texas. It will be the first work of its kind to evaluate the efficacy of academic detailing with specific regard to SUD treatment training and practice uptake, measuring changes in awareness, knowledge, understanding, clinician confidence, and intent to adopt and implement substance use screening and interventions, such as MAT for SUD, into daily practice. Process evaluation of engagement and outreach strategies will guide program modification and expansion. The program will 1. Develop and implement engaging AUD and OUD educational outreach strategies, including academic detailing and innovative, interactive, computer-based asynchronous tools, for 300 practicing primary care providers in the GHMR and the RGV, Texas and 2. Evaluate the extent to which intensive academic detailing improves the effectiveness of a comprehensive, interactive, asynchronous outreach program on awareness, knowledge, understanding, and intent to incorporate AUD/OUD screening and treatment protocols into practice.
Alcohol and other substance use disorders are a national problem. Evidence-based methods for clinicians to address the problem are available but lack sufficient engagement, training, and practical resources. This program will establish innovative training and practice implementation resources while testing their efficacy.
